Fitness
Breast Cancer Treatment Doesn’t Bar Motherhood for Most Women
May 30, 2024 — Maggie Louks was diagnosed with breast cancer 12 years ago at the age of 28. The nurse practitioner from Boston, who now lives in London, was worried about a lot after her diagnosis — including the effect her treatment might have on her ability to get pregnant and have a healthy child in the future.
Louks’s doctors wanted to treat her cancer aggressively, given the fact she was so young at the time she was diagnosed.
“The standard of care at the time was for me to receive ‘kitchen sink chemo’ – basically, they threw the book at me with intensive medication, in the hopes of minimizing recurrence,” said Louks, who is now 40.
Louks later switched to a less intensive chemo regimen, which was successful. She was also proactive about fertility preservation. When she finished her cancer treatment, she started to try to get pregnant. A first attempt at embryo transfer didn’t work, but she was able to harvest new eggs through IVF retrieval.
“We transferred two embryos, which resulted in beautiful twin girls, Sloane and Everly, born in July 2020,” she said. A year later, she and her partner conceived spontaneously, eventually welcoming what she called a “third miracle baby” named Kingsley.
Breast cancer is less common in women of reproductive age but isn’t rare; 10% of diagnosed patients are 45 and under. The happy ending Louks described may seem out of reach to a young woman newly facing breast cancer, but fresh research is proving it’s possible for a large segment of these patients.
A new study is the first to follow young breast cancer survivors for over 10 years after treatment. The long duration from treatment to pregnancy outcomes allowed the researchers to clearly see the details that meant success for these women for the first time.
“The majority of women we followed who tried to get pregnant did, and the majority of those women had live births,” said senior study author Ann Patridge MD, MPH, vice chair of medical oncology and director of the adult survivorship program at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston. “This is really good news, as is the fact that the vast majority of women diagnosed will live well past their breast cancer.”
The Research
More than 1,000 women – 1,213 to be exact – took part in the study. Of these patients, 197 told the researchers they actively tried to get pregnant after their breast cancer treatment. The researchers said 73% of the women attempting to conceive did get pregnant, and 65% had a live birth.
The researchers found that young breast cancer survivors conceived a child at the average age of 32. This was true no matter the stage of their cancer when diagnosed and treated. Older women had less success conceiving.
What’s more, 50% of the women who successfully conceived had never been pregnant before, and 72% who went on to have a healthy child had never given birth to a full-term baby. Twenty-eight percent of the participants had frozen their eggs or embryos prior to receiving chemo.
“Women who banked their eggs or embryos were more likely to become pregnant and go on to have live births,” said Partridge, noting that 68% of the women who attempted to get pregnant had received chemo, which did not appear to have any negative effect on their chances of successful pregnancy.
The majority of participants (76%) had been diagnosed with hormone receptor-positive tumors, which often requires endocrine therapy, and 57% of these women had undergone this hormonal therapy during their cancer treatment.
“It’s not recommended that women taking it should try to get pregnant,” Partridge said. But within the group of women in the study, “I suspect that some of them became pregnant while on it, and also some women stopped their treatments early to try to become pregnant,” she said.
Previous research results by Patridge from a study called the POSITIVE Trial showed that women could safely stop endocrine treatment for a period.
In that trial, she said, researchers found that women could stop their therapy after 18 to 30 months of treatment, wait a few months, and then try to get pregnant through IVF. Many would get pregnant, give birth, and nurse before going back on hormonal therapy.
“Most importantly, with POSITIVE, we found that most women did get back on their endocrine therapy and did have a safe outcome. The number of cancer recurrences in the group was below the safety threshold,” she said.
The key takeaway: A significant number of women can, and do, have healthy babies years after surviving breast cancer. But this does not mean that pregnancy should be attempted by every young breast cancer survivor.
“The decision is very personal – between a woman, her loved ones, and her doctor, regarding the remaining risk of recurrence,” Partridge said. “You have to ask yourself, ‘Am I comfortable with bringing another life into the world if I do have a recurrence and an uncertain future?’ We all have an uncertain future, but if you have survived breast cancer, it’s important to make the choice that is right for you.”
What Is Oncofertility?
For women who do want to attempt pregnancy, oncofertility, an emerging field of medicine that combines both cancer and reproductive disciplines, can be of vital help.
“Oncofertility is a bridge between oncology and reproductive health,” said Laurie McKenzie, MD, associate professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center in Houston.
The goal of oncofertility is to maximize a woman’s reproductive chances through procedures such as fertility preservation. Fertility preservation can help women avoid damage to their reproductive system, such as to their ovaries, by using shielding during radiation treatments, regulating the ovaries through injection therapy, or through surgically moving the ovaries so they’re protected during cancer treatments. And the need for this technology is clear: Recent research from the University of Hong Kong found that only about 44% of women with breast cancer have even heard of fertility preservation, yet through oncofertility, many of these patients can safely and successfully have babies. A recent French study also found that many women with breast cancer also don’t know they can have access to or a consultation with an oncofertility specialist, so it’s important for patients to speak to their primary doctor and request a referral.
An oncofertility specialist can help a newly diagnosed patient weigh all of her options, including freezing her eggs. Many women may not realize how much time this process can take.
“It takes 2 to 3 weeks to undergo egg freezing,” said McKenzie. “Not all patients are good candidates, so before you consider this, it’s important to know what your baseline fertility status is.”
In addition, genetic concerns can also be addressed with an oncofertility specialist.
“If you are concerned about BRCA1 or BRCA2, there are ways to avoid passing it on to your offspring,” McKenzie said. Preimplantation genetic testing is one such option a specialist can inform a patient about.
Knowledge Is Power
Louks remains healthy and believes that learning early about fertility is vital for every young breast cancer patient.
“My advice is to talk about it with your oncology team from the beginning,” she said. “Discuss all of your options and how they might impact your treatment course. Also, think beyond breast cancer. After receiving that devastating diagnosis, it can be very hard to see past the first few weeks and months – but think about the years ahead of you.”
Louks is living proof that a happy outcome is possible for many women who have breast cancer who still dream of becoming a mother.
“Our house is wild and crazy and beautiful, and I am so grateful every day,” she said.
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